STANDARDIZED, PLAIN LANGUAGE EMERGENCY CODES ...

STANDARDIZED, PLAIN LANGUAGE EMERGENCY CODES Implementation Guide

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Table of Contents

Table of Contents Letter From the President...................................................................................................... 2 Executive Summary............................................................................................................... 3 Recommendation................................................................................................................... 6 Background...................................................................................................................................... 6 Goals................................................................................................................................................. 6 Principles.......................................................................................................................................... 7

Time Line......................................................................................................................................... 7

Rationale........................................................................................................................................... 8 Recommendation............................................................................................................................ 9 Emergency Code Notification: Overhead Paging Versus Silent Notification Systems................10 Implementation Strategy......................................................................................................12

Facility Alerts................................................................................................................................. 16

Weather Alerts............................................................................................................................... 18

Security Alerts............................................................................................................................... 20

Medical Alerts............................................................................................................................... 22

Appendices:........................................................................................................................ 23

Appendix A: MHA Standardized Code Workgroup Members.............................................. 23

Appendix B: MHA Emergency Preparedness Advisory Committee Members................... 24

Appendix C: 2012 MHA Emergency Preparedness Survey: Current Emergency Codes........................................................................................................... 25

Appendix D: Hospital Participation Pledge.............................................................................. 27

Appendix E: Sample Hospital Checklist.................................................................................... 28

Appendix F: Sample Hospital Policy.......................................................................................... 31

Appendix G: Sample Hospital Competency Checklist............................................................ 33

Appendix H: Sample Hospital Poster......................................................................................... 35

Appendix I: Frequently Asked Questions.................................................................................. 36

References and Acknowledgements...................................................................................... 38 Implementation Guide

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Dear Missouri Hospital Chief Executive Officers: As president and CEO of the Missouri Hospital Association, I am pleased that the MHA Board of Trustees endorses the adoption of standardized, plain language emergency codes throughout Missouri hospitals and facilities. The use of standardized codes will increase transparency, reduce patient errors using a simple and practical approach and promote the safety of patients, hospital employees and visitors. The standardized codes were developed by a workgroup of 30 hospitals and the recommendation of the MHA Emergency Preparedness Advisory Committee. The decision to adopt standardized codes followed the requests of many Missouri hospitals. In 2012, MHA conducted a survey and found significant variation among hospitals, including nine different emergency codes that were used to notify staff of a hospital evacuation. Even in specific geographic regions and metropolitan areas, the variation was significant. Each hospital will need to review the endorsed codes and determine which are most appropriate for adoption. Although the initiative is voluntary, you are encouraged to consider adoption of all standardized codes. MHA has provided an implementation guide to assist hospitals with this transition. The goal is to have all Missouri hospitals using these standardized, plain language emergency codes by Jan. 1, 2014. Sincerely,

Herb B. Kuhn MHA President and CEO

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STANDARDIZED, PLAIN LANGUAGE EMERGENCY CODES

Executive Summary Background In mid-2011, the Missouri Hospital Association began receiving requests from its members to lead an initiative to standardize the emergency codes used in Missouri hospitals. The requests came from all areas of the state and from health systems, as well as small, rural hospitals. This follows a national trend to standardize emergency codes as recommended by the Joint Commission in 2012. Further, there is a trend to adopt plain language versus color code announcements. The adoption of plain language is supported by the following organizations or reports. U.S. Department of Health and Human Services U.S. Department of Homeland Security ■■ The National Incident Management System (2008) ■■ The Institute of Medicine’s Health Literacy report and recommendations (2004) ■■ ■■

There is no one definition for plain language, but two criteria are generally recognized.

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People understand the information received without further extensive explanation. ■■ People know what actions are required based on the information received. ■■

MHA 2012 Hospital Assessment Based on these requests, MHA surveyed hospitals about their current code nomenclature and invited participation in a workgroup. Among the 134 hospitals that responded to the survey, representatives from 30 hospitals agreed to serve on the workgroup, and the following information was identified. Four different codes were used to announce a fire. Seven different codes were used to announce a medical emergency. ■■ Six different codes were used to announce an abduction of an infant, child or adult. ■■ Seven different codes were used to announce a severe weather alert. ■■ Nine different codes were used to announce a mass casualty event. ■■ Seven different codes were used to announce a hazardous spill. ■■ Nine different codes were used to announce a hospital evacuation. ■■ Ten different codes were used to announce a security threat. ■■ ■■

The workgroup has been meeting since July 2012 and has established the following objectives and principles.

Implementation Guide

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Executive Summary

Objectives for the Standardized Emergency Code Workgroup Reduce variation of emergency codes among Missouri hospitals. Increase competency-based skills of hospital staff working in multiple facilities. ■■ Increase staff, patient and public safety within hospitals and campuses. ■■ Promote transparency of safety protocols. ■■ Align, if possible, standardized codes with neighboring states. ■■ ■■

Principles for Adopting Standardized Emergency Codes The following principles were developed to guide the development of the initiative. This is a voluntary initiative; it is not a mandate to adopt all or any of the recommended emergency codes. ■■ The recommendations are based on scholarly literature and national safety recommendations. ■■ Use of plain language emergency codes is the long-term goal of this initiative to ensure transparency and patient and public safety. ■■ Minimizing overhead pages in hospitals is encouraged to provide a quieter hospital environment, leading to improved safety and patient outcomes. ■■

Implementation Strategy This voluntary initiative is intended to improve patient and public safety and is not a prescriptive mandate; hospitals are not mandated to adopt all or any of the emergency codes. The implementation will be phased in during a one-year time frame. Several hospitals participating in the workgroup have begun using the recommended emergency codes. MHA will provide resources and guidance to hospitals. Each hospital will need to review these recommendations with their emergency preparedness committees and hospital leadership and governance. It is important that each hospital carefully consider each emergency code as a separate issue. It is encouraged, but not required, that a hospital adopt the recommendations for all emergency codes.

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Executive Summary

Standardized, Plain Language Emergency Code Recommendation Missouri hospitals are committed to ensuring patient and public safety within each hospital facility. The recommendation to adopt standardized emergency codes has been developed by experts from hospitals across Missouri and is based on scholarly literature, research and national guidelines. Missouri hospitals are encouraged to adopt the following standardized, plain language codes to further protect patient and public safety within hospitals and health care facilities. This transition should be completed by Jan. 1, 2014.

FACILITY ALERT Event

Recommended Plain Language

Alternate Code

Evacuation

“Facility Alert + Evacuation + Descriptor (location)”

None

Fire

“Code Red + Descriptor (location)”

Plain Language

Hazardous Spill

“Facility Alert + Hazardous Spill + Descriptor (location)”

Code Orange

WEATHER ALERT Event Severe Weather

Recommended Plain Language “Weather Alert + Descriptor (threat/location) + Instruction”

Alternate Code None

SECURITY ALERT Event


Alternate Code

Abduction

“Security Alert + Descriptor (threat/location)”

Code Pink

Missing Person

“Security Alert + Descriptor”

None

Armed Violent Intruder/Active Shooter/Hostage


Code Silver

Bomb Threat


Code Black

Combative Patient/ Person

“Security Alert + Security Assistance Requested + (location)”

None

MEDICAL ALERT Event


Alternate Code

Mass Casualty

“Medical Alert + Mass Casualty + Descriptor”

None

Medical Decontamination

“Medical Alert + Medical Decontamination + Descriptor”

None

Medical Emergency

“Code Blue + Descriptor (location)”

Plain Language

Note: Because of the widely accepted use of the two color codes for fire and medical emergency, the workgroup determined it appropriate to maintain these two color codes as the primary recommendation, with plain language as the secondary recommendation. Implementation Guide

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Recommendation Background In mid-2011, MHA received several member requests to lead an initiative to standardize the emergency codes used to notify staff, patients and visitors. Examples include the emergency codes used to announce a fire, abduction, medical emergency or an armed violent intruder. Based on these requests, in January 2012, MHA included survey questions about current emergency codes in its annual emergency preparedness capacity assessment survey. The results provided evidence of significant variability across the state and even within geographic regions. The following graph illustrates that variability (see Appendix C for the full survey results). MHA staff convened a workgroup representing 140 Clear Language 30 hospitals of all sizes across Code Red 120 Missouri to study national Code Orange Code Yellow literature, including other 100 Code Green state programs, to develop 80 Code Blue a recommendation for Code Pink 60 standardized emergency Code Gray codes (see Appendix B for the 40 Code White Code Black committee roster). This group 20 Code Silver provided considerable time Other Code 0 and expertise to ensure full Fire Medical Abduction Severe Weather Mass Casualty Hazardous Spill Security Evacuation Emergency consideration of this initiative, Source: 2012 MHA Member Hospitals Annual Emergency Preparedness Capacity Assessment including the resources n = 134 hospitals required for implementation. The following recommendation was developed by the MHA Standardized Emergency Code Workgroup, with input from the MHA Emergency Preparedness Advisory Committee.

Missouri - Current Codes

Coordination

Goals The goals of this initiative are to: reduce variation of emergency codes among Missouri hospitals ■■ increase competency-based skills of hospital staff working in multiple facilities ■■ increase staff, patient and public safety within hospitals and campuses ■■ promote transparency of safety protocols ■■ align, if possible, standardized codes with neighboring states ■■

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Recommendation

Principles for Adopting Standardized, Plain Language Emergency Codes The following principles were developed to guide the development of the initiative. This is a voluntary initiative; it is not a mandate to adopt all or any of the emergency codes recommended. ■■ The recommendations are based on scholarly literature and national safety recommendations. ■■ Use of plain language emergency codes is the long-term goal of this initiative to ensure transparency and patient and public safety. ■■ Minimizing overhead pages in hospitals is encouraged to provide a quieter hospital environment, leading to improved safety and patient outcomes. ■■

Implementation Time line It is the recommendation of the workgroup that all participating hospitals adopt the standardized codes by January 2014. The following implementation time line was developed to support hospitals throughout 2013.

Planning

April 2013:

announce new initiative and recommendation

April 2013:

provide hospitals resources to support implementation

May 2013:

conduct webinars to provide additional education and answer questions

June 2013:

seek hospitals’ intent to adopt specific codes and date of adoption

August 2013:

conduct webinars to provide updates and answer questions; share implementation strategies among participating hospitals

January 2014: standardized emergency codes among participating hospitals adopted

June 2014:

evaluate implementation status


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Recommendation

Rationale for Plain Language Emergency Codes In an era of increased transparency, there are several national initiatives to promote plain language among many disciplines, including health care providers and emergency managers. Plain language is a central tenet of health literacy and has been adopted to demonstrate improved patient safety outcomes (Institute of Medicine, 2004). Staff who are new or work at multiple hospitals may not recall unique code nomenclature, resulting in an adverse action. For example, based on the 2012 MHA survey, there are nine different code colors or names currently used for both mass casualty and security alerts. Even regional variation is significant, as evidenced by nine codes for security in one Missouri region (see Appendix C). There is no one universal definition for plain language, but current adoption follows these two criteria (Redish, 2000; U.S. Health and Human Services, n.d.). ■■ ■■

People understand the information received without further extensive explanation. People know what actions are required based on the information received.

The recommendation to use plain language also is evident in the field of emergency preparedness. The use of “10” codes such as “10-40” are no longer recommended or used among law enforcement and public safety officials. The National Incident Management System has established the following plain language requirements for communication and information management (U.S. Department of Homeland Security, 2008, pg. 29).

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“The ability of emergency management/response personnel from different disciplines, jurisdictions, organizations and agencies to work together depends greatly on their ability to communicate with each other. Common terminology enables emergency management/response personnel to communicate clearly with one another and effectively coordinate activities, no matter the size, scope, location or complexity of the incident.” “The use of plain language (clear text) in emergency management and incident response is a matter of public safety, especially the safety of emergency management/response personnel and those affected by the incident. It is critical that all those involved with an incident know and use commonly established operational structures, terminology, policies and procedures. This will facilitate interoperability across agencies/organizations, jurisdictions and disciplines.” The NIMS guidance provides the framework for health care preparedness and response, including the use of the incident command system. Adoption of standardized, plain language also is an emerging trend among other states. Several states have adopted standardized codes during the past few years, and nearly all have included recommendations for plain language codes, including Kansas.

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Recommendation

Standardized, Plain Language Emergency Code Recommendation Missouri hospitals are committed to ensuring patient and public safety within each hospital facility. The recommendation to adopt standardized emergency codes has been developed by experts from hospitals across Missouri and is based on scholarly literature, research and national guidelines. Missouri hospitals are encouraged to adopt the following standardized, plain language codes to further protect patient and public safety within hospitals and health care facilities. This transition should be completed by Jan. 1, 2014.

FACILITY ALERT Event


Alternate Code

Evacuation


None

Fire


Plain Language

Hazardous Spill


Code Orange

WEATHER ALERT Event Severe Weather

Recommended Plain Language “Weather Alert + Descriptor (threat/location) + Instruction”

Alternate Code None



Alternate Code

Abduction


Code Pink

Missing Person


None



Code Silver

Bomb Threat


Code Black

Combative Patient/ Person


None

MEDICAL ALERT Event


Alternate Code

Mass Casualty


None



None

Medical Emergency


Plain Language

Note: Because of the widely accepted use of the two color codes for fire and medical emergency, the workgroup determined it appropriate to maintain these two color codes as the primary recommendation, with plain language as the secondary recommendation. Implementation Guide

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Emergency Code Notification Overhead Paging versus Silent Notification In 2001, the Institute of Medicine issued a report, “Quality Chasm,” identifying six aims of patient quality and safety: safe, timely, effective, efficient, equitable and patient-centered. This landmark report has served as the foundation for many national initiatives to improve patient safety and clinical outcomes. Excessive noise in a hospital setting has been attributed to negative clinical outcomes. Research suggests that “Hospital noise has been associated with patient risk for sleep disturbance, cardiovascular response, increased length of stay, increased incidence of re-hospitalization and other problems” (Ryherd, Okcu, Ackerman, Zimring and Persson, 2011, pg. 491). A study by the University of Virginia Health System identified noise as the most important irritant to surgical patients (Moore, Nguyen, Nolan, Robinson, Ryals, Imbrie & Spotnitz, 1998). This study and others led to the inclusion of noise as core measures for patient satisfaction in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) reported on the U.S. Department of Health and Human Services’ website, Hospital Compare. The measure captures the percentage of patients who report “that the area around their room was always quiet at night” (Hospital Compare, n.d.). Further, research also suggests excessive noise may contribute to the overall stress, job performance and job satisfaction among hospital staff (Ryherd, 2011). Noise must be considered as a contributing factor in patient outcomes and perhaps staff performance and stress, as well. However, when assessing the use of overhead paging versus call notification processes, it is important to reference the National Fire Protection Association’s Life Safety Code 101 to ensure compliance with alarm annunciation (2012). Based on this premise, the committee recommends the following considerations when determining methods of emergency code notification.

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Emergency Code Notification

Overhead paging likely is appropriate when: ■■ the situation requires all or many building occupants hear the notice ■■ the situation requires additional or follow-up information to all or many building occupants ■■ the situation requires an immediate response from all staff ■■ recommended based on the NFPA Life Safety Code compliance Call notification or mass texting to identified groups of staff likely is appropriate when: ■■ the overall goal is to reduce excessive noise within the hospital ■■ the situation requires specific staff have immediate notice for response ■■ the patient population may be considered easily excitable, such as behavioral patients Many hospitals use established call notification systems. For those that do not, Missouri hospitals have access to a hospital-based call notification system through the EMResource™ — Hospital Incident Command System. This system may be set up to send emergency notifications to all or select hospital staff. This system also establishes notification of area hospitals’ emergency preparedness personnel to expedite communication and coordination for emergencies requiring regional response.

Commu nication


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Implementation Strategy

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Implementation Strategy This voluntary initiative is intended to improve patient and public safety; it is not a prescriptive mandate. Resources provided in this toolkit provide implementation ideas and guidance. Hospitals will need to review these recommendations with their emergency preparedness committees, hospital leadership and governance. It is important each hospital carefully consider each emergency code as a separate issue. It is encouraged, but not required, that a hospital adopt all standardized codes. The toolkit provides information, policy templates and educational materials to assist hospitals. However, hospitals may need to develop additional materials for their specific badging or card systems. It is recommended hospitals follow these steps to implement standardized, plain language codes once the hospital has established formal organizational approval and decision to adopt the codes. The steps and time lines are guidance only and should be modified to meet organizational priorities and approaches.

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ACTION steps Nine Months Before Implementation: Awareness Draft a letter from the CEO or governance board and disseminate widely among hospital employees and key external stakeholders. ■■ Include an announcement in the employee newsletter. ■■ Recognize any employees or committees willing to help implement the plain language codes. ■■ Announce a “go-live” date. ■■

Eight Months Before Implementation: Establish Committees Authorize a committee to review and update all policies. Authorize a committee to review and update all hospital materials. ■■ Authorize a committee or individuals to update the hospital emergency operations plan. ■■ Authorize a committee or individuals to update all code cards, flip charts, posters or other emergency management tools. ■■ Authorize a committee or individuals to update all telecommunication scripts, algorithms and materials. ■■ Develop a formal education plan for all employees. ■■ Identify train-the-trainers to serve as educators and champions, announce the trainers’ names to hospital employees and schedule the trainer training. ■■ Establish and promote mechanisms for broad-based, frequent organizational communication, which may include the following. ◗◗ periodic staff emails ◗◗ periodic newsletter articles providing updates and progress ◗◗ posters, flyers or other materials that include the “go-live” date ■■ ■■

Seven Months Before Implementation: Training Plan Conduct train-the-trainer competency-based training. Finalize education plan. ■■ Develop draft education materials; do not mass produce. ■■ Provide update to hospital governance board, leadership team and key external stakeholders. ■■ ■■


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Six Months Before Implementation: Finalize Policy and Training Begin pilot testing hospital employee training. Revise training plan and materials based on pilot testing. ■■ Schedule organizationwide training sessions. ■■ Finalize and produce education materials. ■■ Finalize policies. ■■ ■■

Five Months Before Implementation: Training and Policy Dissemination Begin organizationwide training. Disseminate all materials to each hospital department. ■■ Disseminate all revised policies. ■■ Begin to disseminate posters, flyers and other awareness materials. ■■ Consider a challenge between hospital departments to complete training requirements. ■■ ■■

Four Months Before Implementation: Updates Provide an update in the employee newsletter on the progress, include the “go-live” date. Continue with competency-based education. ■■ Continue to disseminate posters, flyers and other awareness materials. ■■ Update hospital governance and key external stakeholders as appropriate. ■■ ■■

Three Months Before Implementation: Reinforcement Continue organizationwide training. ■■ Continue communication through posters, newsletters, staff meetings and other forums as appropriate. ■■

Two Months Before Implementation: Finalize Complete organization-wide training. Continue communication through posters, newsletters, staff meetings and other forums as appropriate. ■■ Ensure updated policies are available for all hospital employees. ■■ Ensure the emergency operations plan has been updated and formally adopted. ■■ Ensure all emergency management tools and resources have been updated. ■■ Ensure all telecommunication scripts, algorithms and materials have been updated. ■■ Ensure public safety partners (fire, police, EMS) are aware of the new policies, codes and “go-live” date. ■■ ■■

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One Month Before Implementation: Prepare for “Go-Live” Date Begin a daily or weekly countdown until the “go-live” date. ■■ Develop a mechanism to ensure clarification of any questions. ■■ Ensure all department managers are ready to implement the new codes. ■■ Provide broad communitywide articles to educate the public on this change. ■■ Display awareness materials with the “go-live” date throughout the organization. ■■ Ensure trainers are available to answer questions. ■■ Communicate readiness to hospital governance and leadership team. ■■ Recognize employees and committees for their work to ensure a successful implementation. ■■

Implementation

One Month Post Implementation: Initial Evaluation Congratulate and recognize employees and committees for leading a successful implementation. ■■ Congratulate and recognize all employees for a successful implementation. ■■ Assess adoption of plain language codes in staff meetings, education sessions and leadership team meetings. ■■ Conduct department drills to assess adoption during the first five months. ■■

Six Months Post Implementation: Evaluation ■■

Conduct an organizationwide drill to assess adoption six months post-implementation.


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FACILITY ALERTS Purpose: Provide for the safety and security of patients, employees and visitors at all times, including the management of essential utilities. Types of Facility Threats Evacuation ■■ Fire ■■ Hazardous spill (does not include mass patient decontamination alert) ■■

Facility Utilities Electrical power Water ■■ Fuel ■■ Medical gasses, ventilation and vacuum systems ■■ ■■

National Recommendations for Policies and Protocols The Joint Commission The Joint Commission includes the management of safety, security and utilities as two of the six critical functions of an emergency operations plan. Specifically, the Joint Commission includes the following as elements of performance (Joint Commission Resources, 2012, pgs. 104, 145, 158). How the organization will: manage hazardous materials and waste control the entrance into and out of the facility during an incident ■■ control individual movement within the facility during an incident ■■ control vehicular access to the facility during an incident ■■ manage a utility failure caused by an interruption of services ■■ establish back-up systems for critical utilities ■■ provide alternate sources and methods of providing: ◗◗ electricity ◗◗ potable water ◗◗ nonpotable water ◗◗ fuel ◗◗ medical gasses and vacuum systems ■■ manage the personal hygiene and sanitation of patients ■■ ■■

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National Fire Protection Association The National Fire Protection Association’s Life Safety Code 101 provides detailed codes and recommendations about fire prevention, protection and alarm annunciation.

Supporting Information and References Joint Commission Resources (2012). Emergency management in health care: an all hazards approach (2nd ed). ISBN: 978-1-59940-701-2. National Fire Protection Association (2012) Life Safety Code 101. Retrieved March 15, 2013, from http://www.nfpa.org/aboutthecodes/aboutthecodes.asp?docnum=101.

Educat

ion


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Weather Alerts Purpose: Provide clear, plain language instructions and situational awareness to hospital employees, patients and visitors. Glossary of Weather-Related Events, cited directly from the National Weather Service Flash Flood — A rapid and extreme flow of high water rushing into a normally dry area, or a rapid water level rise in a stream or creek above a predetermined flood level that begins within six hours of the causative event (e.g., intense rainfall, dam failure, ice jam). However, the actual time threshold may vary in different parts of the country. Ongoing flooding can intensify to flash flooding in cases where intense rainfall results in a rapid surge of rising flood waters. Flood Watch — Issued to inform the public and cooperating agencies that current and developing hydrometeorological conditions are such that there is a threat of flooding, but the occurrence is neither certain nor imminent. Flood Warning — (FLW) In hydrologic terms, a release by the NWS to inform the public of flooding along larger streams in which there is a serious threat to life or property. A flood warning will usually contain river stage (level) forecasts. Heat Advisory — Issued within 12 hours of the onset of the following conditions: heat index of at least 105°F but less than 115°F for less than three hours per day or nighttime lows above 80°F for two consecutive days. Severe Thunderstorm — A thunderstorm that produces a tornado, winds of at least 58 mph (50 knots), and/or hail at least 1 inch in diameter. Structural wind damage may imply the occurrence of a severe thunderstorm. A thunderstorm wind equal to or greater than 40 mph (35 knots) and/or hail of at least 1 inch is defined as approaching severe. Tornado Watch — This is issued by the National Weather Service when conditions are favorable for the development of tornadoes in and close to the watch area. Their size can vary depending on the weather situation. They are usually issued for duration of four to eight hours. They normally are issued well in advance of the actual occurrence of severe weather. During the watch, people should review tornado safety rules and be prepared to move to a place of safety if threatening weather approaches. A tornado watch is issued by the Storm Prediction Center (SPC) in Norman, Okla. Before the issuance of a tornado watch, SPC will usually contact the affected local National Weather Forecast Office (NWFO), and they will discuss what their current thinking is on the weather situation. Afterwards, SPC will issue a preliminary tornado watch, and then the affected NWFO will then adjust the watch (adding or eliminating counties/parishes) and then issue it to the public. After 18



adjusting the watch, the NWFO will let the public know which counties are included by way of a Watch Redefining Statement. During the watch, the NWFO will keep the public informed on what is happening in the watch area and also let the public know when the watch has expired or been canceled. Tornado Warning — This is issued when a tornado is indicated by the WSR-88D radar or sighted by spotters; therefore, people in the affected area should seek safe shelter immediately. They can be issued without a tornado watch being already in effect. They are usually issued for a duration of around 30 minutes. A tornado warning is issued by your local NWFO. It will include where the tornado was located and what towns will be in its path. If the thunderstorm that is causing the tornado also is producing torrential rains, this warning also may be combined with a flash flood warning. After it has been issued, the affected NWFO will be followed periodically with severe weather statements. These statements will contain updated information on the tornado, and they also will let the public know when the warning is no longer in effect. Wind Chill Factor — Increased wind speeds accelerate heat loss from exposed skin, and the wind chill is a measure of this effect. No specific rules exist for determining when wind chill becomes dangerous. As a general rule, the threshold for potentially dangerous wind chill conditions is about -20°F. Winter Weather Advisory — This product is issued by the National Weather Service when a low pressure system produces a combination of winter weather (snow, freezing rain, sleet, etc.) that presents a hazard but does not meet warning criteria. Blizzard — A blizzard means that the following conditions are expected to prevail for a period of three hours or longer: sustained wind or frequent gusts to 35 miles an hour or greater and a considerable falling and/or blowing snow (i.e., reducing visibility frequently to less than a quarter of a mile).

Reference National Oceanic and Atmospheric Administration, National Weather Service. (n.d.) Retrieved February 8, 2013, from www.weather.gov.


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Security Alert Purpose: To protect employees, patients and visitors from any situation or person posing a threat to the safety of any individual(s) within the hospital. Types Abduction (all ages) Missing person (all ages) ■■ Armed violent intruder, active shooter, hostage ■■ Bomb threat ■■ Combative person/patient ■■ ■■

National Recommendations for Policies and Protocols The National Center for Missing and Exploited Children The National Center for Missing and Exploited Children offers a free online book and selfassessment form for health care organizations. The book and assessment include recommended actions to prevent an infant abduction and what to do when an abduction occurs. The resources can be found at www.ncmec.org/missingkids/servlet/ResourceServlet?LanguageCountry=en_ US&PageId=468. The PDFs are available directly at www.ncmec.org/en_US/publications/NC05.pdf and www.ncmec.org/en_US/publications/NC05assessment.pdf. The Joint Commission The Joint Commission includes the management of safety, security and utilities as two of the six critical functions of an emergency operations plan. Specifically, the Joint Commission includes the following as elements of performance (Joint Commission Resources, 2012, pg. 104-105). How the organization will: arrange internal security establish roles and coordinate with community public safety and security agencies ■■ establish emergency security planning, which includes: ◗◗ individual movement within the facility, including elevators and stairwells ◗◗ access in and out of the facility ◗◗ vehicular movement on the facility grounds ◗◗ uninterrupted access for ambulances and other response vehicles ◗◗ authorized access for first responders and emergency personnel ■■ ■■

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Missouri Hospital Association The Missouri Hospital Association has policy templates for armed violent intruder response and recommendations for sudden onset incident command action steps.

References: Joint Commission Resources (2012). Emergency management in health care: an all hazards approach (2nd ed). ISBN: 978-1-59940-701-2. Mitigation Dynamics, Inc. (2012). Sample policy templates. Available at www.mhanet.com. National Center for Missing and Exploited Children (n.d). Retrieved February 8, 2013, from www.missingkids.com.


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Medical Alerts Purpose: To provide medical care and support to patients and incident victims while maintaining care and safety of patients, employees and visitors within a health care facility during an incident. Types Mass casualty Medical emergency ■■ Chemical or radiological decontamination ■■ ■■

National Recommendations for Policies and Protocols The Joint Commission The Joint Commission includes the management of clinical care and safety as one of the six critical functions of an emergency operations plan. Specifically, the Joint Commission includes the following as elements of performance (Joint Commission Resources, 2012, pgs. 104, 158). How the organization will : provide for radiological, biological and chemical isolation and decontamination manage patient triage, assessment, treatment, transfer, admission, discharge and scheduling ■■ manage horizontal and vertical patient evacuation ■■ manage increased demand for clinical services ■■ manage increased demand for mental health services ■■ manage mortuary services ■■ track patients location and clinical information ■■ ■■

Supporting Information and References Joint Commission Resources (2012). Emergency management in health care: an all hazards approach (2nd ed). ISBN: 978-1-59940-701-2.

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Appendices

APPENDIX A: MHA STANDARDIZED CODE WORKGROUP MEMBERS Name

Title

Organization

Andrew Atkinson

Regional Quality Improvement Officer

Missouri Department of Mental Health

Michael Behringer, RRT

Emergency Preparedness Coordinator

Bates County Memorial Hospital

Debbie Blinzler, R.N., BSN

Education Coordinator

Cox Monett

April Burchett

Administration Department Secretary

Cedar County Memorial Hospital

Jo Ann Cantriel, R.N., BSN

Education Manager

Capital Region Medical Center

Joy Cauthorn, R.N., BSN, CIC

Infection Control Nurse

Missouri Delta Medical Center

Derek Collins


Saint Luke's Health System

Russ Conroy, RRT, MBA


Mercy Hospital Springfield

Christie A. DeArman, R.N.

Compliance Officer/Education Director

Southeast Health Center of Stoddard County

Spencer Dobbs

Safety Officer

Mercy Hospital Joplin

Rhonda Dorrell, R.N.

Director of Emergency Services

Audrain Medical Center

Steve Fine

Network Coordinator Emergency Management

SSM DePaul Health Center

Jenni Fleming

Director of Security/Emergency Preparedness Coordinator

Cass Regional Medical Center

Miranda Floyd, R.N., BSN

Chief Nursing Officer

Northwest Medical Center

Robert J. Grayhek, R.N., BSN

Director, Trauma and Disaster Services

Saint Francis Medical Center

Debbie Halinar, R.N.

Director, Infection Control/Safety

Phelps County Regional Medical Center

Frank Hayden

Director, Ancillary Services

Hedrick Medical Center

Jason Henry, R.N., CEN, EMT

Emergency Management Officer (Corporate)

Cox South

Damon C. Longworth

Chief Financial Officer

Missouri Department of Mental Health CPS - Southeast Region

Linda S. Maly, R.N., BSN, LNHA

Safety Officer

St. Luke's Hospital

Beverly Morris, R.N.

Emergency Department Nurse Manager

Cox Monett

Gary Douglas Ruble, CPE, CPMM, RHSO

Vice President, Facilities

Hannibal Regional Healthcare System

Lou Smith

Risk/Safety Manager

Cox Medical Center Branson

Matthew C. Soule

Safety Director

Children's Mercy Hospitals and Clinics

Jeffery J. Stackle


Madison Medical Center

Leslie Sutton, R.N.

Director of Quality Management

Landmark Hospital of Columbia

Carolyn S. Wells, R.N.

Director, Trauma Services

Liberty Hospital

Eamonn Wheelock

Safety & Emergency Preparedness Coordinator

University Hospital and Clinics

Steve Williams, CHSP

Senior Director Corporate Support Services Safety Compliance

Truman Medical Centers Inc.

Karen Wilson, R.N.

Emergency Room Director/Disaster Management

Mercy Hospital Aurora

Sarah Yelton

Quality Resource Analyst

Saint Luke's Hospital of Kansas City Implementation Guide

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Appendices

APPENDIX B: MHA EMERGENCY PREPAREDNESS ADVISORY COMMITTEE MEMBERS

24

Name

Title

Organization

Andrew Atkinson

Regional Quality Improvement Officer


Linda G. Brown, MSN, R.N., APRN, BC, FNP-C Director, Emergency Services

SoutheastHEALTH

Stephanie Browning

Director

Columbia/Boone County Health Department

Rita M. Brumfield, R.N., MSN

Chief Nursing Officer

Ste. Genevieve County Memorial Hospital

Russ Conroy, RRT, MBA



Melissa Friel

Director

Missouri Department of Health and Senior Services

Jerry Glotzer

Director, Environmental Health/Safety

Barnes-Jewish Hospital

Josephine E. Goode Evans

Corporate V.P., Risk Services

SSM Health Care

Kathy Hadlock, R.N., BSN

Healthcare Systems Preparedness Program Manager

Missouri DHSS, Center for Emergency Response and Terrorism

Jason Henry, R.N., CEN, EMT

Emergency Management Officer (Corporate)

Cox South

Sonia Jordan

MRC Region 7 Regional Coordinator

Office of the Civilian Volunteer Medical Reserve Corps

Kimberly S. Lowe, LPN

Manager, Patient Safety/PI

Mercy St. Francis Hospital

Dan Manley, EMT-P

Emergency Services Planner

Mid-America Regional Council

Dennis G. Manley, R.N., BSN, HRM, CPHQ

Vice President of Quality, Interim Chief Nursing Officer

Mercy Hospital Joplin

Amy J. Michael

Chief Operating Officer

Sullivan County Memorial Hospital

Wallace N. Patrick, R.N.

Emergency Management Coordinator

Heartland Regional Medical Center

Robert Patterson

Director, Emergency Medical Services


Chris Pickering

Homeland Security Coordinator

Missouri Office of Homeland Security, Department of Public Safety

Janice Pirner, CPHQ, LPN

Member Services Manager

Missouri Primary Care Association

Leslie L. Porth, R.N., MPH

Vice President of Health Planning

Missouri Hospital Association

Vanessa Poston

Environmental Health & Safety Manager

Missouri Baptist Medical Center

Gary Douglas Ruble, CPE, CPMM, RHSO

Vice President, Facilities

Hannibal Regional Healthcare System

George Salsman

Network Director, Emergency Preparedness/ Safety

SSM Health Care - St. Louis

Helen Sandkuhl, R.N., MSN, FAEN

Nursing Director of Emergency Services

Saint Louis University Hospital

David Schemenauer

Director, Safety, Security and Emergency Preparedness

Saint Luke's Health System

Chris A. Smith, MHA, MEP

Manager, Communications and Emergency Preparedness

University Hospital and Clinics

Matthew C. Soule

Director, Safety

Children's Mercy Hospitals and Clinics

G. Mark Thorp

Fire Chief

Clayton Fire Department

Julie Weber, BS Pharm, CSPI

Director, MO Poison Center

SSM Cardinal Glennon Children’s Medical Center

Janet Weckenborg, BSN, MHA, FACHE

Vice President, Operations

Capital Region Medical Center

Carolyn S. Wells, R.N.

Director, Trauma Services

Liberty Hospital

John H Whitaker

Public Safety Administrator

St. Louis Area Regional Response System

Jenny Wiley

Coordinator, Disaster Readiness


Joseph V. Yust

Facilities Director

Freeman Neosho Hospital


Appendices

APPENDIX C: 2012 MHA ANNUAL EMERGENCY PREPAREDNESS SURVEY: CURRENT EMERGENCY CODES — n = 134 hospitals

Fire

Code Red Code Yellow

6%

Code Green

9% 1%

Code Green 33%

Code Pink

Code Gray

Code Gray Code White

35% 13%

Code Black

Code Black Code Silver

Code Silver

Other Code

2%

Other Code

Mass Casualty

Clear Language Code Red

1%

13%

11%

0%

Code Green

Code Green Code Blue

29%

37%

Code Pink Code White 74%

Code Black Code Silver Other Code


Code Yellow

Code Gray

Clear Language Code Orange

Code Orange 1%

Code Blue

Code Pink Code White

Medical Emergency


7%

Code Blue

90%

Clear Language Code Orange

Code Orange

3%

1%

Severe Weather

Clear Language

Code Blue Code Pink Code Gray

2%

Code White

7% 2%

2%

10% 5%

6%

Code Black Code Silver Other Code


25

Appendices

Abduction

Security

Clear Language Code Red

13%

Code Yellow

Code Yellow Code Green

46%

Code White Code Black

1%

Code Silver

1%

Hazardous Spill

30% 2% 3%

5%

Code Gray Code White

18% 6%

6%

Other Code

4%

Evacuation

Code Red

Code Red Code Orange

Code Yellow

Code Yellow Code Green

Code Blue Code Pink

2%

Code Gray

3%

Code Black Other Code


Clear Language

Code Orange

Code White 31%

Code Black Code Silver

Clear Language

Code Silver

26

Code Pink

Code Green

23%

Code Blue

6% 7%

Other Code

9%

1%

Code Pink Code Gray

2%

Code Green

19%

28%

Code Blue

38%

Code Red Code Orange

Code Orange 1%

Clear Language

1%

Code Pink 5%

2%

Code Blue

21%

61%

Code Gray Code White Code Black

3% 2%

Code Silver Other Code

Appendices

APPENDIX D: HOSPITAL PARTICIPATION PLEDGE

MISSOURI HOSPITAL ASSOCIATION STANDARDIZED EMERGENCY CODE PLEDGE I am pleased to announce that

HOSPITAL NAME

is participating in the Missouri Hospital Association initiative to standardize plain language emergency codes across Missouri. Hospital personnel often are employed or practice at more than one health care facility, and variation among emergency codes increases the potential for error, resulting in a risk to patient, employee and visitor safety. To reduce variation, is adopting the following standardized emergency codes.

HOSPITAL NAME

CHECK ALL CODES ADOPTED WITH THIS PLEDGE FACILITY ALERT Event 


Alternate Code

Evacuation


None

Fire


Plain Language

Hazardous Spill


Code Orange

WEATHER ALERT Event 


Severe Weather

Alternate Code

“Weather Alert + Descriptor (threat/location) + Instruction”

SECURITY ALERT Event 


None

Alternate Code

Abduction


Code Pink

Missing Person


None



Code Silver

Bomb Threat


Code Black

Combative Patient/Person


None

MEDICAL ALERT Event 


Alternate Code

Mass Casualty


None



None

Medical Emergency


Plain Language

CEO NAME

CEO SIGNATURE

HOSPITAL NAME

DATE


27

Appendices

APPENDIX E: SAMPLE HOSPITAL CHECKLIST Nine Months Before Implementation: Awareness Draft a letter from the CEO or governance board and disseminate widely among hospital employees and key external stakeholders. Include an announcement in the employee newsletter. Recognize any employees or committees that will help implement the plain language codes. Announce a “go-live” date. Eight Months Before Implementation: Establish Committee

Authorize a committee to review and update all policies. Authorize a committee to review and update all hospital materials. Authorize a committee or individuals to update the hospital emergency operations plan. Authorize a committee or individuals to update all code cards, flip charts, posters or other emergency management tools. Authorize a committee or individuals to update all telecommunication scripts, algorithms and materials. Develop a formal education plan for all employees. Identify train-the-trainers to serve as educators and champions, announce the trainers’ names to hospital employees and schedule the trainer training. Establish and promote mechanisms for broad-based, frequent organizational communication, which may include the following: periodic staff emails periodic newsletter articles providing updates and progress develop posters, flyers or other materials that include the “go-live” date

Seven Months Before Implementation: Develop Training

Conduct train-the-trainer competency-based training. Finalize education plan. Develop draft education materials; do not mass produce. Provide update to hospital governance board, leadership team and key external stakeholders.

Six Months Before Implementation: Finalize Policy and Testing

28

Begin pilot testing hospital employee training. Revise training plan and materials based on pilot testing. Schedule organizationwide training sessions. Finalize and produce education materials. Finalize policies.


Appendices

Five Months Before Implementation: Training Dissemination

Begin organizationwide training. Disseminate all materials to each hospital department. Disseminate all revised policies. Begin to disseminate posters, flyers and other awareness materials. Consider a challenge between hospital departments to complete training requirements.

Four Months Before Implementation: Updates

Provide an update in the employee newsletter on the progress, include the “go-live” date. Continue with competency-based education. Continue to disseminate posters, flyers and other awareness materials. Update hospital governance and key external stakeholders as appropriate.

Three Months Before Implementation: Finalize Continue organizationwide training. Continue communication through posters, newsletters, staff meetings and other forums as appropriate. Two Months Before Implementation: Reinforce

Complete organizationwide training. Continue communication through posters, newsletters, staff meetings and other forums as appropriate. Ensure updated policies are available for all hospital employees. Ensure the emergency operations plan has been updated and formally adopted. Ensure all emergency management tools and resources have been updated. Ensure all telecommunication scripts, algorithms and materials have been updated. Ensure public safety partners (fire, police, EMS) are aware of the new policies, codes and “go-live” date.

One Month Before Implementation: Prepare for Go-Live Date

Begin a daily or weekly countdown until the “go-live” date. Develop a mechanism to ensure clarification of any questions. Ensure all department managers are ready to implement the new codes. Provide broad communitywide articles to educate the public on this change. Display awareness materials with the “go-live” date throughout the organization. Ensure trainers are available to answer questions. Communicate readiness to hospital governance and leadership team. Recognize employees and committees for their work to ensure a successful implementation.


29

Appendices

Implementation One Month Post Implementation: Initial Evaluation

Congratulate and recognize employees and committees for leading a successful implementation. Congratulate and recognize all employees for a successful implementation. Assess adoption of plain language codes in staff meetings, education sessions and leadership team meetings. Conduct department drills to assess adoption during the first five months.

Six Months Post Implementation: Evaluation Conduct an organizationwide drill to assess adoption six months post-implementation.

30


Appendices

APPENDIX F: SAMPLE HOSPITAL POLICY Subject: Hospital Emergency Operations

Policy Number: ______________________________

Effective Date: _______________________________

Dates of Revision: ____________________________

Authorized Approval: _________________________ Policy Name: Standardized Emergency Codes Purpose: This policy is intended to provide all staff specific guidance and instruction on how to initiate an emergency code within the hospital. Policy Objectives: The purpose of standardized, plain language emergency codes among Missouri hospitals is to: reduce variation and the potential for error among Missouri hospital staff who may work or have privileges in more than one facility ■■ promote transparency of safety protocols for employees, patients and visitors ■■

Definitions Policy: In the event of an emergency situation, a plain language emergency code will be used to notify the appropriate individuals to initiate an immediate and appropriate response based on the hospital emergency operations plan. The emergency code activation may or may not include widespread notification, based on the incident and established emergency procedures. Procedures 1. Initiating an Emergency Code Call When initiating an emergency code call, the [hospital] employee should: A. initiate the notification process for the specific emergency, as outlined in the emergency operations plan B. use the plain language code to reduce confusion C. use the established code script i. Facility Alert a. Evacuation: “facility alert + evacuation + location” b. Fire: “Code Red + location” c. Hazardous Spill: “facility alert + hazardous spill + location” ii. Weather Alert a. “Weather alert + descriptor (threat/location) + instructions” iii. Security Alert a. Abduction: “security alert + abduction + location” b. Violent Intruder: “security alert + descriptor (threat/location) + instructions” c. Bomb Threat: “security alert + bomb threat + instructions” d. Combative Person/Patient: “security alert + security assistance requested + location” iv. Medical Alert a. Mass Casualty: “medical alert + mass casualty + descriptor (location/instructions)” b. Medical Emergency: “Code Blue + location” Implementation Guide

31

Appendices

2. Terminating an Emergency Code A. Once the emergency situation has been effectively managed or resolved, and based on the emergency operations plan, the code should be canceled. An indication of “all clear” should be sent to all that received the initial notification. This command should be repeated three times. B. The cancelation notification should be sent via the same notification process as the initial code activation. For example, if an overhead paging system was used to activate the code, the overhead paging system should be used to cancel the code. 3. Providing Competency-based Staff Education Competency-based education about the plain language emergency codes should be provided to all employees during employee orientation and reviewed during annual life-safety updates. Physicians, public safety officers and other contract employees also should be provided education. Education should include the following. A. four categories of alerts (facility, weather, security, medical) B. immediate steps for emergency code activation and notification of appropriate personnel based on the [hospital] emergency operations plan C. specific responsibilities, based on their job description as written in the emergency operations plan References Healthcare Association of Southern California (2011) Health care emergency codes: a guide for code standardization, (3rd ed). Retrieved February 8, 2013, from www.HASC.org. Minnesota Hospital Association (n.d.) Plain language emergency overhead paging: implementation toolkit. Retrieved February 8, 2013, from www.mnhospitals.org/patient-safety/current-safety-quality-initiatives/ emergency-overhead-pages.

32


Appendices

APPENDIX G: SAMPLE HOSPITAL COMPETENCY CHECKLIST

COMPETENCY CHECKLIST (SAMPLE) Employee Name:_____________________________ Employee Number:___________________________ Title:_______________________________________ Unit: ______________________________________ Method of Evaluation:

Skills Validation

DO-Direct Observation

Emergency Code Standardization Process

VR-Verbal Response

Method of Evaluation

WE-Written Exam

Initials

OT-Other

Comments

Patient, staff and visitor safety Access to emergency code policy and procedure Definitions of each emergency code How to call each emergency code When it is appropriate to call each code Staff responsibilities after calling or hearing a code

Name of Skills Validator:_____________________________________________________________________ Signature of Skills Validator:_______________________________________ Date:___________________ I received a copy of the Standardized Emergency Codes (Policy or Badge-Buddy). I understand the Emergency Code procedures for the hospital and my role in safety. I agree with this competency assessment. I will contact my supervisor, manager or director, if I require additional training in the future. Employee Signature:______________________________________________ Date:___________________ Reference Healthcare Association of Southern California (2011) Health care emergency codes: a guide for code standardization, (3rd ed). Retrieved February 8, 2013, from www.HASC.org. Minnesota Hospital Association (n.d.) Plain language emergency overhead paging: implementation toolkit. Retrieved February 8, 2013, from www.mnhospitals.org/patient-safety/current-safety-quality-initiatives/ emergency-overhead-pages.


33

Appendices

APPENDIX H: SAMPLE HOSPITAL POSTER A sample hospital poster template is provided on Page 35.

34


Emergency Codes FACILITY ALERT Event


Alternate Code

Evacuation


None

Fire


Plain Language

Hazardous Spill


Code Orange

WEATHER ALERT Event

Severe Weather


“Weather Alert + Descriptor (threat/ location) + Instruction”

Alternate Code

None



Alternate Code

Abduction

“Security Alert + Descriptor (threat/ location)”

Code Pink

Missing Person


None

Armed Violent Intruder/ Active Shooter/Hostage


Code Silver

Bomb Threat


Code Black

Combative Patient/Person


None

MEDICAL ALERT Event


Alternate Code

Mass Casualty


None



None

Medical Emergency


Plain Language

Appendices

APPENDIX I: FAQs Why is the Missouri Hospital Association endorsing and leading an initiative to adopt standardized, plain language emergency codes? MHA and member hospitals are committed to increasing patient, employee and visitor safety during any incident. The need to standardize emergency codes had been recognized by hospital emergency preparedness staff, especially in communities with more than one hospital or adjacent to nearby states. The decision to adopt plain language was proactive and based on literature, research and early trends among hospitals to promote transparency and safety. The early trend aligns with new federal initiatives to adopt plain language standards. How did MHA develop these specific codes for standardized use? MHA asked for volunteers from the 134 hospitals that submitted the 2012 annual emergency preparedness survey. Among those respondents, 30 hospitals agreed to have representation on the committee; this included critical access hospitals and large health care systems. MHA facilitated the process, and the group, which first convened in July 2012, met regularly to develop the plain language standardized code recommendations. Consensus and voting were the two primary methods used for decision making. Why is plain language important? The adoption of plain language promotes transparency, increases safety and aligns with national initiatives. The Institute of Medicine considers plain language a central tenet of health literacy (2004). The National Incident Management System also has established plain language requirements for communication and information management among emergency managers (2008). Why did the Missouri recommendations maintain two color codes: code red for fire and code blue for medical emergencies? The standardized emergency code workgroup determined these two codes are so common and institutionalized that maintaining these two color codes would reduce resistance, increase compliance and would not negatively affect patient, employee or visitor safety. It is important to note the workgroup did recommend plain language as the only acceptable alternative for these two codes. Does use of plain language create additional fear among patients and visitors? Although this is a commonly expressed concern, research suggests that plain language does not create additional fear among patients and visitors. In fact, it may decrease uncertainty among patients and visitors. Does use of plain language reduce patient privacy or protection? If policy implementation adheres to principles of privacy and HIPAA, use of plain language should not adversely affect patient privacy.

36


Appendices

How should a hospital determine which emergency codes to announce to all patients, visitors and employees and which emergency codes to announce to only specific hospital personnel? It is important that each hospital consult its emergency management and leadership teams to determine appropriate policies and procedures for the organization. As a general rule, the trend is to reduce the amount of overhead paging and announce overhead only those codes that at least the majority of patients, employees and visitors should be aware of and prepared to respond. How should hospitals handle security issues such as an armed violent intruder? It is important that each hospital consult its emergency management and leadership teams to determine appropriate policies and procedures for the organization. As a general rule, hospitals should consider overhead announcements when there is a confirmed or likely armed violent intruder. Is adoption of any or all of these plain language emergency codes mandatory? Although this initiative is strongly encouraged and endorsed by the MHA Board of Trustees, there is no regulation requiring adoption of any or all of these standardized, plain language emergency codes. Is there a time line to implement plain language? There is a target date of Jan. 1, 2014, for hospitals to implement these emergency codes.


37

References

References and Acknowledgements Chadhury H., Mahmood, A., Valente, M. (2009). The effect of environmental design on reducing nursing errors and increasing efficiency in acute care settings: a review and analysis of the literature. Environment and Behavior. 41:755-787. Doi:10.1177/00139 16508330392. Healthcare Association of Southern California (2011) Health care emergency codes: a guide for code standardization, (3rd ed). Retrieved February 8, 2013, from www.HASC.org. Hsu, T. Ryherd, E., Persoon Waye, K, Ackerman, J. (2012) Noise pollution in hospitals: impact on patients. J. Clinical Outcomes Management. 19(10): 301-309. Institute of Medicine (2001). Crossing the quality chasm: a new health care system for the 21st century. ISBN 0-309-07280-8. Institute of Medicine (2004). Health literacy: a prescription to end confusion. ISBN. 0-309-09117-9. Joint Commission Resources (2012). Emergency management in health care: an all hazards approach (2nd ed). ISBN: 978-1-59940-701-2. MacKenzie, D.J., Galbrun, L. (2007). Noise levels and noise sources in acute care hospital wards. Building Services Engineering Research and Technology. 28:117-131. Doi:10.1177/0143624406074468. Moore, M.M., Nguyen, D., Nolan, S.P., Robinson, S.P., Ryals, B., Imbrie, J.Z., Spotnitz, W. (1998) Interventions to reduce decibel levels on patient care units. 64(9) 894-899. Retrieved December 6, 2012, from http://search. proquest.com.ezp.waldenulibrary.org/healthcomplete/docview/213098125/fulltextPDF/13AD6E7A6AE2E341F55/6 ?accountid=14872. Minnesota Hospital Association (n.d.) Plain language emergency overhead paging: implementation toolkit. Retrieved February 8, 2013, from http://www.mnhospitals.org/patient-safety/current-safety-quality-initiatives/ emergency-overhead-pages. Mitigation Dynamics, Inc. (2012). Sample policy templates. Available at www.mhanet.com. National Center for Missing and Exploited Children (n.d). Retrieved February 8, 2013, from www.missingkids.com. National Fire Protection Association (2012) Life Safety Code 101. Retrieved March 15, 2013, from www.nfpa.org/aboutthecodes/aboutthecodes.asp?docnum=101. National Oceanic and Atmospheric Administration, National Weather Service. (n.d.) Retrieved February 8, 2013, from www.weather.gov. Redish J.C. (2000). What is information design? Technical Communication; 47(2):163-166. Ryherd, E., Okcu, S., Ackerman, J., Zimring, C., Persson Waye, K. (2012). Noise pollution in hospitals: impact on staff. J. Clinical Outcomes Management. 19(11): 491-500. 38


Acknowledgements

U.S. Department of Health and Human Services. (n.d.) Hospital compare. Retrieved December 6, 2012, from www.hospitalcompare.hhs.gov/. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion (n.d.) Plain language: a promising strategy for clearly communicating health information and improving health literacy. Retrieved December 6, 2012, from http://www.health.gov/communication/literacy/plainlanguage/ PlainLanguage.htm. U.S. Department of Homeland Security (2008) National incident management system. Retrieved December 6, 2012, from www.fema.gov/sites/default/files/orig/fema_pdfs/pdf/emergency/nims/NIMS_core.pdf. U.S. Department of Homeland Security, Office of Emergency (2010) Plain language FAQs. Retrieved December 6, 2012, from www.safecomprogram.gov/SiteCollectionDocuments/PlainLanguageFAQs.pdf. Suggested Citation Porth, L., (2013) MHA Standardized, Plain Language Emergency Codes: Implementation Guide. Missouri Hospital Association. Available at www.mhanet.com. MHA Staff Contact Leslie Porth, R.N., MPH Vice President of Health Planning [email protected] 573/893-3700, ext. 1305

Jackie Gatz, MPA Director of Emergency Preparedness [email protected] 573/893-3700, ext. 1330

Carissa Hutson Manager of Emergency Preparedness [email protected] 573/893-3700, ext. 1329

Cindy Soule Emergency Preparedness Coordinator [email protected] 573/893-3700, ext. 1307

Acknowledgement Missouri Hospital Association would like to acknowledge the following committees for their work and support of the standardized code initiative. MHA Standardized Emergency Code Workgroup MHA Emergency Preparedness Advisory Committee MHA Board of Trustees MHA also recognizes the following state hospital associations for their work on standardized emergency codes. Kansas Hospital Association Minnesota Hospital Association Southern California Hospital Association Wisconsin Hospital Association


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© 2013 Missouri Hospital Association P.O. Box 60 � Jefferson City, MO, 65102-0060 � www.mhanet.com

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